Since the Minnesota legislative session started, there have been hundreds of new bills introduced, including two that are of interest concerning caregivers, home care and home care agencies. Both were introduced on February 6, and both were authored by Sen. Jerry Relph (R -St. Cloud). Together the bills are aimed at easing the workforce shortage that the disability community and home care industry are experiencing.
The first, Senate File 318, Certified Paraprofessionals for Home Care Services, creates a career ladder and paraprofessional status for home care workers. The legislation would allow these paraprofessionals, after a 40-hour training program approved by the Health and Human Services commissioner, and under regular supervision by a registered nurse, to do many of the tasks that were previously only permitted for LPNs. On introducing the legislation, the author added an amendment to disallow the use of paraprofessionals with ventilator-dependent clients. There was quite a bit of discussion and opposition concerning this bill. Some in the gallery were saying that this bill was only starting the conversation on how to resolve the workforce shortage in skilled nursing for home care, and it would take several more years to work out. It sure seems like a good start, even allowing that there is a lot to work out in order to increase the pool of providers while maintaining a safe, independent quality of life for individuals with extremely high needs. The companion bill, House File 464, went to the Health and Human Services Reform committee, which is working on the challenge of how to guarantee individuals’ rights to live in the least restricted environment in a way that is financially sustainable for the state.
The second of Senator Relph’s bills addressing the home care workforce shortage is Senate File 393. It was explained in a hearing by Jeff Bangsberg, who has come out of retirement and has worked determinedly to foster this legislation through the lawmaking process. There was also very compelling and diverse testimony by Don Dania, Carla Frieze and Jim Carlisle. Each of them spoke about a different aspect of the hardship the workforce shortage has created for them and their personal networks. They spoke about friends who have gone without care for weekends, others who at the 11th hour averted being admitted to the hospital over the holidays, some whose PCAs are burning out from overwork, and others who have paid the ultimate price for the workforce shortage and lost their lives.
SF 393 would authorize an additional 20 percent reimbursement increase for home care agencies whose PCAs serve people who qualify for 10 or more hours of daily care in the home. Current law requires that the agencies provide 72.5 percent of the reimbursement to the direct support person in wages or benefits. The legislation would also add a training requirement (CNA or equivalent level of knowledge/expertise) for PCAs in order to receive the enhanced wage. To receive the higher wage, a PCA would have to have suitable training and guidance specifically for working with a person with high needs. If the PCA has training but is working for someone who does not require complex services, they would be paid at the regular PCA reimbursement rate.
Those with complex care needs are having a profoundly difficult time finding needed caregivers. This increase in reimbursement rate would potentially open up more agencies to accepting complex-need clients, because not only is it more challenging to find PCAs, it’s tough to find quality agencies that will shoulder consumers with complicated and stressful needs. Because the situation is particularly urgent for those with complex needs, SF 393 focuses on PCAs who serve those individuals. The companion, House File 481, will be introduced later in the month.
Each of us knows, directly or through many friends and colleagues, about the unprecedented workforce shortage of PCAs—for all state program participants, and for direct-pay clients. The entire disability community should support the governor’s budget, which includes a substantial reimbursement increase for all PCAs.
So remember: in order for any of this legislation to be passed, the disability community has to show up in numbers. Don’t forget Tuesdays at the Capitol, don’t forget calling and writing or asking your disability organization to help you help them support the needs of all of us with disabilities.
Stay warm and safe and call a friend to make sure they’re safe. The days are getting longer, and we can hope that we’ll get brighter days in more ways than one.